Protein-Losing Enteropathy

Often, the biopsy is taken using an endoscope, which is a minimally- ABOUT THE DIAGNOSIS invasive procedure, but if the biopsy results are inconclusive (since Protein-losing enteropathy (PLE) is the term used for describing any endoscopic biopsy specimens are small and superficial), it may disease of the digestive system in which proteins from the blood be necessary to obtain a further set of biopsies at a later date plasma are lost into the intestinal tract and evacuated in the feces. through abdominal surgery. Patients with protein-losing enteropathy When the protein losses exceed the body’s capacity to replenish who undergo abdominal surgery usually need a plasma transfusion them, the concentrations of the proteins in the blood fall below beforehand, since plasma contains a high concentration of blood normal. Blood proteins act to maintain the fluid balance between proteins and therefore helps offset the body’s shortage of proteins the blood and other body elements and are also important in tissue needed for postoperative healing. Overall, confirming protein-losing healing, immune defense, coagulation (blood clotting), and many enteropathy is a step-wise process that can be time-consuming, other processes. When the protein levels in the blood are too low, but which determines the best course of treatment and the outlook fluid begins to shift from the blood into the tissues and spaces of (prognosis) for recovery. the body. This fluid shift can cause edema (fluid accumulation in the tissues of the dependent parts of the body, such as under the LIVING WITH THE DIAGNOSIS skin of the feet and legs) or effusions (fluid accumulation in body The outlook for protein-losing enteropathy varies widely depending spaces, such as the abdomen and chest). Furthermore, the loss upon the specific cause. Some conditions are curable, but others of blood proteins can lead to emaciation (severe, unintentional require lifelong daily treatment at home with periodic rechecks. Still weight loss), immune deficiencies, increased risk of blood clots, others are severe diseases, such as some types of cancer, which and other problems. threaten the life of the pet. There are many causes of protein-losing enteropathy. These include inflammatory and infectious diseases of the intestines, such TREATMENT as inflammatory bowel disease, parasites (worms,Giardia , and Specific treatment depends upon the cause of the protein-losing many others), and certain fungal diseases such as histoplasmosis; enteropathy. Some causes are curable, such as intestinal parasitism immune-mediated diseases, such as food allergies and gluten or obstructions caused by foreign bodies. Others require long-term intolerance; long-standing partial intestinal obstructions, including treatment of the underlying condition. Intestinal lymphangiectasia, for those caused by foreign bodies or tumors; and disruption of the example, is managed by feeding a low-fat diet and sometimes with intestinal lymphatic flow calledlymphangiectasia . Some causes of treatment using corticosteroids (cortisone-like drugs). Other causes protein-losing enteropathy have a genetic component, even if the of protein-losing enteropathy such as immune-mediated intestinal signs don’t become evident until the animal is middle aged. diseases are managed with hypoallergenic diets and corticosteroids. Weight loss is a prominent symptom of protein-losing enteropa- Supportive care may be required, depending on your pet’s thies, but it may not be recognized because the belly can become symptoms. If fluid accumulation in the belly impairs breathing, it enlarged due to fluid accumulation. Most dogs with protein-losing may need to be drained. Often, a low dose of aspirin or another enteropathy also have diarrhea. Vomiting may sometimes occur. drug is given to prevent blood clots from forming abnormally. In most The other signs are related to the low protein levels. These include cases, vitamin B supplementation is required at least temporarily. swelling of the dependent areas of the body such as the legs Dietary restrictions are often a crucial part of ongoing therapy. and scrotum. If fluid accumulates in the chest, breathing difficulty develops because the lungs do not have enough space to expand. DOs The presence of one or some of these symptoms in a dog or • Give all medications exactly as directed. cat brings up the possibility of protein-losing enteropathy and can • Follow dietary recommendations closely, with no treats or snacks prompt your veterinarian to recommend some tests to evaluate or that have not been okayed by your veterinarian. confirm this disorder. • Understand that protein-losing enteropathy is an umbrella term Routine blood profiles will show low levels of blood proteins— for several intestinal diseases and that proper treatment requires usually both the albumin and globulin fractions—in protein-losing determining the exact nature of the cause. In turn, this often enteropathy. However, blood tests do not evaluate intestinal function requires advanced testing including an intestinal biopsy. specifically. First, further testing is needed to eliminate other causes • Pay attention to your pet’s stool characteristics. Is it watery, of low blood protein levels, because there are many causes of low or softer than normal? Does it appear greasy? Is it covered in blood protein levels, and then to determine which of the many causes mucus? This can provide useful information for your veterinarian. of protein-losing enteropathy is present. The other common causes • Consider a second opinion with a veterinary internal medicine of very low protein levels are liver disease and kidney disease. A expert if the diagnosis is unclear, or for the latest treatment options. urinalysis and liver function tests help rule out these problems. These specialists are known as Diplomates of the American (or Common causes of similar fluid accumulations despite normal European) College of Veterinary Internal Medicine (directories: blood protein levels include tumors and heart disease, and x-rays www.acvim.org, www.vetspecialists.com, www.ecvim-ca.org). may be used to look for preliminary evidence of such disorders, They can be recommended to you by your veterinarian and are especially if the blood protein level is only slightly decreased. If no found in most larger North American and European cities. evidence is found of disease external to the gastrointestinal tract, several laboratory tests can be used for narrowing the possible DON’Ts gastrointestinal causes, including repeated fecal (stool) tests for • Do not give treats that are not consistent with dietary intestinal parasites. Often, however, a final diagnosis can only be recommendations. made by putting an animal under general anesthesia, taking intestinal • Do not look at just the abdomen (belly) to determine whether biopsies, and submitting the tissues for microscopic examination. lost weight is being regained because fluid accumulation in the

From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved. belly may look like gained weight even though it is only retained fluid. The prominence of the ribs and backbone (to the touch ROUTINE FOLLOW-UP in any pet, and visibly in short-coated dogs and cats) are more • Varies with the cause of the condition, and should be discussed accurate indicators of body condition. at every visit.

WHEN TO CALL YOUR VETERINARIAN Other information that may be useful: “How-To” Client Education • Breathing difficulty is an emergency situation that can occur if Sheet: fluid retention compresses the lungs within the chest (pleural • How to Collect a Fecal Sample effusion), or if a blood clot forms in the lungs. • If the ribs and spine of your pet are becoming more prominent, signaling weight loss even if the belly is big. • Vomiting or diarrhea begin to occur, or increase in frequency. SIGNS TO WATCH FOR As indicators of the onset, or recurrence, of protein-losing enteropathy: • Weight loss • Diarrhea, sometimes with vomiting • Swelling of the legs or scrotum • Swelling of the abdomen • Difficulty breathing Practice Stamp or Name & Address

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